Larry Adelman a San Francisco filmmaker poses for a portrait in San Francisco on January 16, 2008 after winning the prestigious Alfred I. duPont-Columbia Award for excellence in broadcast journalism for his documentary "Unnatural Causes: Is Inequality Making Us Sick?."

Photo: Frederic Larson, The Chronicle

Larry Adelman a San Francisco filmmaker poses for a portrait in San...

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Larry Adelman a San Francisco filmmaker poses for a portrait in San Francisco on January 16, 2008 after winning the prestigious Alfred I. duPont-Columbia Award for excellence in broadcast journalism for his documentary "Unnatural Causes: Is Inequality Making Us Sick?."

Photo: Frederic Larson, The Chronicle

Larry Adelman a San Francisco filmmaker poses for a portrait in San...

San Francisco filmmaker Larry Adelman will be in New York City next week to receive the prestigious Alfred I.duPont-Columbia University Award for excellence in broadcast journalism for his documentary "Unnatural Causes: Is Inequality Making Us Sick?" The four-hour series aired last spring on PBS. A central theme of the film is that social factors - education, income and place of residence - play a greater role in longevity and overall health in the United States than genes, health insurance and access to health services. Chronicle staff writer Victoria Colliver sat down with the filmmaker, co-director of California Newsreel in San Francisco, to talk about health disparities and the opportunities for reform.

Q:In the film, you explore the social causes that make people sick. What do you mean by these social determinants of health?

A: The jobs we do, the wage we're paid, the neighborhoods we live in, the schools we attend and, most of all, the power we have to control the factors that impinge upon our lives have been absent from this debate.

It should come as no surprise that the United States has the greatest inequalities of all the rich countries and the worst health. But why is our policy debate just talking about health care? By expanding the dialogue to include what's called the social determinants of health equity, all we're doing is helping people understand that the conditions in which we live our lives - in which we are born, work and play - are even stronger predictors of your health status than diet, smoking and exercise.

Q:What about health insurance or access to health care? How much of a role does that play in one's health status?

A: It turns out that most research shows that differential access to health care treatment is probably responsible for anywhere from 10 to 20 percent - depending on the study - of health inequities. The rich ($80,000 and up annual individual income) will live not just six years more than the poor, but two years longer on average than white middle-class people like myself. About 10 to 20 percent can be explained by access to health care, unequal access to treatment.

Q:What kinds of decisions do people make based on where they live and what level of education they have?

A: The choices we make are constrained by the choices we have. It's hard to get your five to seven fruits and vegetables a day if there are no supermarkets in your neighborhoods and you have to take two buses to get there. Yet you've got fast-food restaurants all over the place, mom-and-pops, 7-Elevens. The same thing, by the way, applies in a different way to people who live in the exurbs. Again, it's hard to get your five to seven fruits and vegetables if you have to commute an hour or so each way. It's not just an inner-city problem; it's also a land-use and transportation problem.

Q: What about the impact of the current economic environment on our bodies?

A: Obviously, we expect that layoffs, foreclosures, ripping holes in the safety net are only going to harm people's health. It's not just losing a job. What research suggests is the uncertainty of not knowing whether or not you're going to have a job has an even greater impact on your health, especially cardiovascular disease, than the layoff itself.

Q:Earlier this week, the series was screened at the state Capitol. What's the message of the film for state politics?

A: The take-away message from the show is that education policy is health policy. Transportation is health policy. Housing policy is health policy. Jobs is health policy. Anything you can do to improve the well-being of people is health policy. In other words, the challenge for any government - municipal, regional, state and federal - is how do you put health in all policies? We need to begin to introduce into all discussions of social policies their health consequences.

Q:Do you think the new presidential administration will provide the golden moment that many health advocates hope will change the health care debate in this country?

A: It depends. Let's take a look at the Depression. The Depression threw all sorts of people out of work and caused all sorts of problems. But out of the Depression came some of the greatest health advances of the 20th century: Social Security, the right to collective bargaining, what became the Federal Housing Administration, the regulation of the banking industry and business, which of course was then repealed. Add to that environmental protections, the war on poverty, the civil rights movement, Medicare and Medicaid, of course. What research shows is these social changes had a greater impact on that 30-year increase in life expectancy that we saw in the 20th century than medical advances.